Editorial Friday 26 October 2012: Ipsos MORI polling for DH finds growing public dislike and distrust of the NHS reforms

We highlighted previously that the long-running British Social Attitudes survey and the NHS staff survey found that staff and the public had pretty dim views of the advisability and feasibility of the current NHS reforms.

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There was significant debate following this whether public concern was about the 'noise' during the passing of the Health And Social Care Act. This intelligent piece by Dan Wellings of Ipsos MORI sets the argument out cogently.

The DH has just published its latest public opinion polling by Ipsos MORI, and it remains a lively read.

The interviews were conducted throughout May, after the passage of the Act at the end of March. So unless the hypothesis is that the public have become health policy obsessives such as we happy few, we can reasonably assume people are opinion on the basis of something other than the Bill-era claims and counter-claims of liberation and privatisation.

Key findings
• Seven in ten (69%) people are satisfied with the current running of the NHS. This matches the level of satisfaction recorded in December 2011 (70%). However, this is now significantly lower than between December 2009 and December 2008 when 73% of the public were satisfied. The number of people saying they are very satisfied with the NHS is now 17%. This has fallen significantly since 24% was recorded in December 2009.

• High levels of satisfaction are being maintained at a local level (75% agree their local NHS provides them a good service) and among service users (71% satisfied). However, there has been a six percentage point fall in agreement that the government has the right policies for the NHS since December 2009 (from 28% to 22% now). This continues a steady decline since 37% was recorded in December 2009. Nearly half of people (45%) now disagree that the government has the right policies.

• These attitudes are likely to be linked to perceptions of the reforms. More than two in five people (43%) think the changes the government is making to the NHS will make services worse for patients (an increase on 38% in December 2011). There has also been a decrease in the proportion agreeing that the NHS is changing so it can provide the service we need for years to come (44% agree now compared to 50% in December 2011).

• The majority (67%) still say they know nothing or very little about the changes being made to the NHS.

• People are now more aware of GP commissioning however. One in five (19%) spontaneously mention the greater involvement of GPs and other healthcare professionals in spending decisions as a change being made to the NHS (up from 13% in December 2011).

• When asked what the changes being made to the NHS involve, 15% say ‘greater provision of services by the private sector’ and 26% say ‘cuts to services’. Seven in ten (70%) of those mentioning either of these perceived reforms expect the changes being made to the NHS to make services worse for patients.

• Overall levels of optimism for the future of the NHS remain divided with 35% expecting it to get better over the next few years, and 32% expecting it to get worse. This is a more positive outlook than was recorded between 2005 and 2010.

• Despite the public’s concerns over NHS policy and reform, pride in the NHS is still strong (71% agree Britain's NHS is one of the best in the world) and more than ever agree that quality is at the heart of the NHS (57%).

• The public increasingly believes that the NHS is working to tackle inefficiency. This wave of the survey records the lowest ever number of mentions of bureaucracy and top heavy management as one of the biggest problems facing the NHS (14%). Although less than half (46%) agree the NHS is doing everything it can to tackle waste and inefficiency, these perceptions have improved over the last 18 months (from 36% agreeing in December 2010).

• The public is now more likely to agree there should always be limits on what is spent on the NHS (58% compared to 44% in 2006). However, the public continues to believe that a lack of resources and investment is one of the biggest problems facing the NHS (39%).

• A majority (82%) also agree that the NHS will face a severe funding problem in future. The public has concerns about the impact of this on the quality of care with less than half (45%) agreeing it is possible to increase quality of care for patients while reducing NHS costs.

Net satisfaction with the running of the NHS continues its post-2010 decline. Those 17 % 'very satisfied' continues the post-2011 rise and 'dissatisfied continues its post-2010 rise - albeit only to 6%.

Ipsos MORI's summary reports "initial signs of a fall in overall satisfaction with the NHS":
• Seven in ten adults (69%) in England are satisfied with the current running of the NHS. This matches the level of satisfaction recorded in December 2011 (70%).

• While this level of satisfaction has been stable for the last two years, it is now significantly lower than between December 2009 and December 2008 when 73% of the public were satisfied.

• Approaching one in five (17%) adults are now dissatisfied with the NHS overall. This is relatively low looking across the full length of the survey, although it has increased since a low of 11% dissatisfied was recorded in December 2009.

• The number of people saying they are very satisfied with the NHS is now 17%. This has fallen significantly since 24% was recorded in December 2009.

• Over this same period the number of people saying they are very dissatisfied with the NHS has increased from 3% in 2009 to 6% now.

Regional satisfaction again finds the north-east the region most happy with the NHS, and the south-east the least happy.

Overall satisfaction of self-identified current NHS users is at 71% (looks like a tiny drop), whereas non-users stand at just 57% (a more significant fall since late 2011 - albeit on a very small sample size; just under 10% of all respondents.

Recent service users professed a small increase in satisfaction with outpatient services, but registered small drops in satisfaction with GP, A&E and inpatient services.

Satisfaction among members of the public who have not recently engaged with any NHS services is significantly lower at 57%. This has fallen from 69% in December 2011. The small number of non-users surveyed (101 in Spring 2012 and 100 in December 2011) means these fluctuations in the results should be treated with caution however.

Government policies
The perception of whether "the government has the right policies for the NHS" shows a further significant decline to 22%. In context, this 22% of the public agreeing that 'the government has the right policies for the NHS' marks a 6% drop from the 28% who agreed with that statement in December 2011. It continues a steady decline since 37% was recorded in December 2009.

Nearly half of people (45%) now disagree that the government has the right policies, up from 39% in December 2011.

There is an interesting split among significant users of the NHS - older people apparently disagree with the Government's NHS policies much more than younger people do. Just 12% of 55-64 year-olds and 18% of 65+ year-olds agree that "the government has the 22 right policies for the NHS".

Some faint good news arises with a small increase in the number who expect the NHS services to improve over coming years and a small decrease in those expecting it will worsen. Asked what are the biggest problems facing the NHS, 'lack of resources / investment' is the overwhelming winner at 39%.

Interestingly, in this 'anticipated problems' category,  'bureaucracy / top-heavy management' has declined as being a concern from 25% of respondents in March 2010 to 14% in the latest data. This suggests that people are noticing the management cuts.

Where ignorance is bliss ...
The 'how much do you know about the government's reforms?' question found that (as in the previous survey) 67% of respondents replied either 'not very much' or nothing at all'. It is a missed opportunity that the survey did not follow this up with 'how much do you wish you knew?'!

When people report spontaneously what they did know about the reforms, there were small increases in the mentions of all of the following:
Doctors / health care professionals commissioning services/having more say in how the NHS is run
Negative / damaging / too many cuts
Cuts in frontline services
Organisational changes / reconfiguration
Hospital closures
Cuts in bureaucracy
Not heard of any changes

There was a large increase in 'Privatisation / more services provided by private sector' and a large reduction in 'don't know'.

'Tis folly to be wise
So does knowing more make people happier? Um, no.

When asked, 'thinking about these changes overall, from what you know, how much better or worse do you think services will be for patients?', 43% report that they will make services a little or much worse for patients (up from 38% December 2011 and 37% December 2010).

When 'those who know something about the changes being made' were asked the same question, those giving overall 'a little or much worse for patients' replies rose to 59% (up from 49% in December 2011 and 53% in December 2010).

44% of respondents agreed that 'the NHS is changing so it can provide the service we need for years to come'; 41% disagreed. The former was a good-sized drop from 50% December 2011, and the latter an increase.

Perceptions that privatisation will make patient services 'a little or much worse' have risen to 70% (up from 60% in December 2011). On the same metric, cuts are static from Decemeber 2011 at 70% - but interestingly, 'doctors and other healthcare professionals commissioning services/ having more of a say in how the NHS is run' now scores 57% (up from 43% December 2011), and 'cuts in managers or cuts in bureaucracy' scores 43% (slightly down from 47% December 2011).

There are corresponding falls in expectations of GP-led commissioning, with 42% expecting it will make care much or a little better (down from 47% December 2011 and December 2010). 73% strongly or tend to agree that 'GPs are best placed to understand which services their patients need' (down from 83% on December 2011 and 79% December 2010). 33% think that a wider range of providers will make services much or a little better, down from 38% in December 2011.

Compared with responses in December 2011, overall 2% fewer agree that 'Britain’s National Health Service is one of the best in the world'; 3% fewer agree that The NHS provides good value for money to taxpayers; and 4% fewer that 'If I was very ill I would feel safe in an NHS hospital'. 8% fewer agree that 'people have increasing choice about their treatment and care; and 5% fewer agree that 'NHS waiting times for non emergency care are getting shorter'.

There have been modest increases on dignity, health promotion and quality issues.

Money no object
On the defining question of whether respondents think 'there should always be limits on what is spent on the NHS', 44% now agree (this was 58% in 2006) and 48% disagree (39% in 2006). This shows that the world is simultaneously growing more and less rational.

The analysis decides that "the majority of the public (82%) agrees that the NHS will face a severe funding problem in the future. At the same time many (58%) agree that there should always be limits on what is spent on the NHS. In 2006, when this question was asked on a different survey, fewer (44%) agreed with this and were outweighed by those believing there should not be limits to spending. This demonstrates a growing agreement among the public that the NHS budget cannot always be protected.

"While less than half of the public (46%) agrees that the NHS is doing everything it can to tackle waste and inefficiency, these perceptions have improved over the last 18 months from 36% agreeing in December 2010.

"There is a perception among two thirds of the public (66%) that the NHS provides good value for money to taxpayers. This has been stable over the past few years of this research".

45% of respondents agreed that 'It is possible to increase quality of care for patients while reducing NHS costs'; 46% disagreed.

There has been a decline from 62% to 55% in those agreeing that 'people have increasing choice about their treatment and care'. 94% of respondents with a long-term condition agreed that 'People have increasing choice about their treatment and care', and 88% of respondents ho provide informal care for others agreed that 'I know where to go for information to help me care for this person'.

A bit of good news
There is some comfort for the Government on health promotion: 60% agreed slightly or a lot that 'the Government is doing more these days to help people live healthier lives' (up from 56% in 2006 and 2007).